| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Departments of Neurology (Drs. Schwarz, Wildemann, and Storch–Hagenlocher) and Neuroradiology (Drs. Mohr and Knauth), University of Heidelberg, Germany.
Address correspondence and reprint requests to Dr. Stefan Schwarz, Department of Neurology, University of Heidelberg, 400 Im Neuenheimer Feld, Heidelberg 69120, Germany; e-mail: stefan_schwarz{at}med.uni-heidelberg.de
OBJECTIVES: To describe the clinical, CSF, and radiologic findings and long-term follow-up in a cohort of patients with acute disseminated encephalomyelitis (ADEM), and to determine possible prognostic factors for progression to MS.
METHODS: Forty adults (28 women, mean age 33.5 years) diagnosed with ADEM were analyzed. Clinical symptoms, cranial MRI and CSF findings, and the response to a standardized treatment during the acute phase of the disease were analyzed by chart review. The final diagnosis of ADEM or clinically definite MS was established upon follow-up examination after 8 to 137 months. The patients with ADEM and MS were compared to detect differences between the two groups.
RESULTS: Fifteen patients had a preceding infection (n = 14) or immunization (n = 1). The most frequent clinical signs were motor deficit (80%), followed by sensory deficits, brainstem signs, and ataxia. CSF findings were highly variable; normal results were present in 20% of patients. Oligoclonal bands were positive in 65% of patients. Ninety-five percent of all patients improved during the acute phase of the disease. Upon follow-up, 14 patients had developed clinically definite MS. Of the 26 patients with the final diagnosis of ADEM, two patients had died, nine had minor deficits, three had moderate deficits, and 12 patients had no remaining symptoms. Patients with the final diagnosis of ADEM were older, and more often had a preceding infection, clinical signs of brainstem involvement, a higher CSF albumin fraction, and infratentorial lesions.
CONCLUSIONS: Many patients initially diagnosed with ADEM develop clinically definite MS upon long-term follow-up. The authors found no useful diagnostic criteria for the differentiation of a first episode of MS from monophasic ADEM. The term ADEM may still be employed as a description of a clinical syndrome, but should not be used as a distinct entity until reliable diagnostic criteria have been developed.
This article has been cited by other articles:
|
|
 |
|
  C. M. Poser Multiple Sclerosis and Recurrent Disseminated Encephalomyelitis Are Different Diseases Arch Neurol, May 1, 2008; 65(5): 674 - 674. [Full Text] [PDF]
|
|
|
|
|
|
E. Tavazzi, S. Ravaglia, D. Franciotta, and E. Marchioni Differential Diagnosis Between Acute Disseminated Encephalomyelitis and Multiple Sclerosis During the First Episode Arch Neurol, May 1, 2008; 65(5): 676 - 677. [Full Text] [PDF]
|
|
|
|
|
|
J. de Seze Differential Diagnosis Between Acute Disseminated Encephalomyelitis and Multiple Sclerosis During the First Episode--Reply Arch Neurol, May 1, 2008; 65(5): 677 - 677. [Full Text] [PDF]
|
|
|
|
|
|
R. Eichel, Z. Meiner, O. Abramsky, and M. Gotkine Acute Disseminating Encephalomyelitis in Neuromyelitis Optica: Closing the Floodgates Arch Neurol, February 1, 2008; 65(2): 267 - 271. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. de Seze, M. Debouverie, H. Zephir, C. Lebrun, F. Blanc, V. Bourg, S. Wiertlewski, S. Pittion, D. Laplaud, E. Le Page, et al. Acute Fulminant Demyelinating Disease: A Descriptive Study of 60 Patients Arch Neurol, October 1, 2007; 64(10): 1426 - 1432. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Tenembaum, T. Chitnis, J. Ness, J. S. Hahn, and for the International Pediatric MS Study Group Acute disseminated encephalomyelitis Neurology, April 17, 2007; 68(16_suppl_2): S23 - S36. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Banwell, M. Shroff, J. M. Ness, D. Jeffery, S. Schwid, B. Weinstock-Guttman, and for the International Pediatric MS Study Group MRI features of pediatric multiple sclerosis Neurology, April 17, 2007; 68(16_suppl_2): S46 - S53. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Kiewe, C. Loddenkemper, I. Anagnostopoulos, M. Reinwald, E. Thiel, and A. Korfel High-dose methotrexate is beneficial in parenchymal brain masses of uncertain origin suspicious for primary CNS lymphoma Neuro-oncol, April 1, 2007; 9(2): 96 - 102. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T Fukazawa and S Kikuchi A three-dimensional approach for understanding the spectrum of idiopathic inflammatory demyelinating disorders: importance of the 'attack-related severity' axis Multiple Sclerosis, March 1, 2007; 13(2): 199 - 207. [Abstract] [PDF]
|
|
|
|
 |
|
 C-H Lin, J-S Jeng, S-T Hsieh, P-K Yip, and R-M Wu Acute disseminated encephalomyelitis: a follow-up study in Taiwan J. Neurol. Neurosurg. Psychiatry, February 1, 2007; 78(2): 162 - 167. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Menge, B. Hemmer, S. Nessler, H. Wiendl, O. Neuhaus, H.-P. Hartung, B. C. Kieseier, and O. Stuve Acute Disseminated Encephalomyelitis: An Update Arch Neurol, November 1, 2005; 62(11): 1673 - 1680. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Marchioni, S. Ravaglia, G. Piccolo, M. Furione, E. Zardini, D. Franciotta, E. Alfonsi, L. Minoli, A. Romani, A. Todeschini, et al. Postinfectious inflammatory disorders: Subgroups based on prospective follow-up Neurology, October 11, 2005; 65(7): 1057 - 1065. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R C Dale and J A Branson Acute disseminated encephalomyelitis or multiple sclerosis: can the initial presentation help in establishing a correct diagnosis? Arch. Dis. Child., June 1, 2005; 90(6): 636 - 639. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Lindzen, A. Gilani, S. Markovic-Plese, and D. Mann Acute Disseminated Encephalomyelitis After Liver Transplantation Arch Neurol, April 1, 2005; 62(4): 650 - 652. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K M Hogarth, W Jan, and J P Lin Multiple cerebral enhancing lesions in an acutely ill child Br. J. Radiol., March 1, 2004; 77(915): 267 - 268. [Full Text] [PDF]
|
|
|
|
|
|
L Bennetto and N Scolding INFLAMMATORY/POST-INFECTIOUS ENCEPHALOMYELITIS J. Neurol. Neurosurg. Psychiatry, March 1, 2004; 75(90001): i22 - 28. [Full Text] [PDF]
|
|
|
|
|
|
S. von Stuckrad-Barre, E. Klippel, C. Foerch, J.-M. Lang, R. du Mesnil de Rochemont, and M. Sitzer Hemicraniectomy as a successful treatment of mass effect in acute disseminated encephalomyelitis Neurology, August 12, 2003; 61(3): 420 - 421. [Full Text] [PDF]
|
|
|
|
|
|
J.-M. Orgogozo, S. Gilman, J.-F. Dartigues, B. Laurent, M. Puel, L. C. Kirby, P. Jouanny, B. Dubois, L. Eisner, S. Flitman, et al. Subacute meningoencephalitis in a subset of patients with AD after A{beta}42 immunization Neurology, July 8, 2003; 61(1): 46 - 54. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Stonehouse, G Gupte, E Wassmer, and W P Whitehouse Acute disseminated encephalomyelitis: recognition in the hands of general paediatricians Arch. Dis. Child., February 1, 2003; 88(2): 122 - 124. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R K Garg Acute disseminated encephalomyelitis Postgrad. Med. J., January 1, 2003; 79(927): 11 - 17. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. L. Simone, D. Carrara, C. Tortorella, M. Liguori, V. Lepore, F. Pellegrini, A. Bellacosa, A. Ceccarelli, I. Pavone, and P. Livrea Course and prognosis in early-onset MS: Comparison with adult-onset forms Neurology, December 24, 2002; 59(12): 1922 - 1928. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Ravin and E. T. Hedley-Whyte Case 34-2002 - A 55-Year-Old Man with Cognitive and Sensorimotor Findings and Intracranial Lesions N. Engl. J. Med., October 31, 2002; 347(18): 1433 - 1440. [Full Text] [PDF]
|
|
|
|
|
|
S. Schwarz, S. Zoubaa, M. Knauth, C. Sommer, and B. Storch-Hagenlocher Intravascular lymphomatosis presenting with a conus medullaris syndrome mimicking disseminated encephalomyelitis Neuro-oncol, July 1, 2002; 4(3): 187 - 191. [Abstract] [PDF]
|
|
|
|
 |
|
 M. Inglese, F. Salvi, G. Iannucci, G. L. Mancardi, M. Mascalchi, and M. Filippi Magnetization Transfer and Diffusion Tensor MR Imaging of Acute Disseminated Encephalomyelitis AJNR Am. J. Neuroradiol., February 1, 2002; 23(2): 267 - 272. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 ADEM or MS? An Important Diagnostic Issue Journal Watch Neurology, September 7, 2001; 2001(907): 6 - 6. [Full Text]
|
|
|
|
 |
|
 E. L. Oleszak, W. L. Lin, A. Legido, J. Melvin, H. Hardison, B. E. Hoffman, C. D. Katsetos, and C. D. Platsoucas Presence of Oligoclonal T Cells in Cerebrospinal Fluid of a Child with Multiphasic Disseminated Encephalomyelitis following Hepatitis A Virus Infection Clin. Vaccine Immunol., September 1, 2001; 8(5): 984 - 992. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-P. Hartung ADEM: Distinct disease or part of the MS spectrum? Neurology, May 22, 2001; 56(10): 1257 - 1260. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
